摘要
目的探讨胸腹腔镜联合食管癌根治术的学习曲线。方法回顾性分析2010年4月至2011年12月由同一治疗组医师完成的144例胸腹腔镜联合食管癌根治术。按照手术日期先后顺序分为A、B、C、D4组，每组36例。比较各组患者的手术时间，术中出血量，淋巴结清扫个数，中转开放手术率，并发症率，住院时间及手术频度，分析不同阶段的手术效果。结果4组患者在年龄、性别、肿瘤侵犯深度，肿瘤位置，中转开放手术率，并发症发生率及手术后住院时问等方面差异均无统计学意义（P〉0．05）。A组手术时间为（339．1±56．5）min，显著长于B组（240．7±58．2）min、C组（255．4±45．7）min和D组（269．9±45．4）min，P〈0．05。A组的术中失血量为（218．6±142．9）min，显著多于B组（106．4±76．0）min、C组（75．5±48．7）min和D组（100．5±91．9）min，P〈0．05。B、C、D三组间差异无统计学意义（P〉0．05）。A组清扫淋巴结的个数为（10．6±5．6）个，显著少于B组（15．6±7．7）个、C组（18．3±6．9）个和D组（18．4±8．7）个，（P〈0．05）。B、C、D三组间差异无统计学意义（P〉0．05）。手术频度由A组的3．9例／月上升到B组的14．4例／月、C组的11．1例／月、D组的10．6例／月，并趋于稳定。结论胸腹腔镜联合食管癌根治术学习曲线大约为36例。
Objective Minimally invasive esophagectomy（MIE） is accepted as standard surgery for treatment of esopha- geal carcinoma. This study investigated the learning curve of Combining thoracoscopy and laparscopy for treatment of esophageal carcinoma. Methods We retrospectively analyzed the clinical data of 144 cases of combined thoracoscopic and laparoscopic esophagectomy performed by the same surgical team. In order of the dates of surgery, the patients were equally divided into groups A, B, C, and D. Comparisons were made among the four groups in operation time,blood loss, number of lymph nodes re- sected ,rate of conversion to open surgery, postoperative complications , postoperative hospital stay, and frequency of surgery. Results No significant differences were found ＂in age, sex, T stage, tumor location, rate of conversion to open surgery, rate of postoperative complications, and postoperative hospital stay among the five groups （ P 〉 0.05 ）. The operation time was signifi- cantly longer in group A than in B, C and D [ （ 339.1 ± 56.5 ） min vs. （ 240.7 ± 58.2 ） rain, （ 255.4 ± 45.7 ） rain and （269.9 ±45.4） min,P 〈0.05, and 5]. The blood loss in surgery was significantly more in group A than the other three groups [ （18.6 ±142.9 ml vs. （106.4 ±76.0） ml, （75.5 ±48.7） ml and （100.5 ±91.9） ml,P 〈0.05]. The number of lymph nodes resected was significantly less in group A than the other three groups [ （ 10.6 ± 5.6） vs. （ 15.6 ± 7.7 ）, （ 18.3 ± 6.9 ） and （ 18.4 ± 8.7 ）, P 〈 0.05 ]. The frequency of surgery was increased from 3.9 eases a month in group A to 14.4, 11.1 and 10.6 cases a month in B, C and D. Conclusion The learning curve of combined laparoscopic and thoracoscopic esophageetomy for esophageal carcinoma is about 36 cases.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2013年第6期354-357,共4页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
胸腔镜
腹腔镜
食管癌
学习曲线
Thoracoscopy Laparoscopy Esophageal carcinoma Learning Curve
